Eş Zamanlı Endometrium ve Over Kanserlerinde Prognostik Faktörler

Abstract

Amaç: Eş zamanlı endometrium ve over kanseri nedeni ile opere edilen hastalarda prognostik faktörlerin incelenmesiYöntem: İzmir Tepecik Eğitim ve Araştırma Hastanesi jinekolojik onkoloji kliniğinde Haziran 1995 – Kasım 2013 tarihleri arasında, eş zamanlı endometrium ve over kanseri nedeni ile tedavi edilen hastalar retrospektif incelendi. Hastalara ait klinik veriler analiz edildi. Prognostik faktörler ve hastaların sağkalım durumları arasındaki ilişkiler değerlendirildi. Kaplan Meier yöntemi ve cox regresyon analizi ile sağkalım analizleri yapıldı.Bulgular: Çalışmada 52 hasta incelendi. Median yaş 51 (28‒74) idi. 14 (%26.9) hastaya pelvik ve para-aortik lenfadenektomi, 32 (%61.5) hastaya sadece pelvik lenfadenektomi yapıldı, 6 (%11.5) hastada lenfadenektomi uygulanmadı. Hastaların %53.8'inde optimal cerrahi gerçekleştirildi. Her iki tümör histolojik tipi hastaların %67.3'ünde endometrioid tipti. Yirmi bir (%40.4) hastaya adjuvan radyoterapi, 44 (%84.6) hastaya adjuvan kemoterapi uygulandı. On-dört (%26.9) hastada nüks saptandı. Ortalama hastalıksız sağkalım süresi 61.5 ay (3‒213) ve toplam sağkalım süresi 75.5 ay (6‒221) idi. 5-yıllık sağkalım %73.1 olarak hesaplandı. Tam cerrahi evreleme uygulanan hasta grubunda, parsiyel yapılmış ve yapılmamış hasta grubuna göre daha iyi toplam sağkalım verileri elde edildi (HR:1.77; GA % 95 1.03‒3.02; p = 0.037). Optimal cerrahi, hastalıksız ve toplam sağkalımı geliştirdi (sırasıyla, HR:0.15; GA % 95 0.01-1.70; p < 0.0001 , HR:3.73; GA % 95 1.60‒8.67; p = 0.039). Her iki tümörü erken evre saptanan hastaların hastalıksız ve toplam sağkalımları daha iyiydi (sırasıyla HR:0.27; GA % 95 0.08-0.97; p = 0.0003 , HR:5,65; GA % 95 2.21-14.43; p = 0.041). 5 yıllık sağkalım, her iki tümör histolojisi endometrioid tipte bulunan hasta grubu için %82.9 iken, non-endometrioid tipte bulunan hasta grubu için %52.9'du (p = 0.023).Sonuç: Eş zamanlı endometrium ve over kanserlerinde, erken evrede tanı alan ve optimal cerrahi yapılan hastalarda prognoz daha iyidir. Tam cerrahi evreleme önemli bir prognostik faktördür. Her iki tümör tipi endometrioid tip olan hastalarda 5 yıllık sağkalım oranı daha yüksektir.

Objective: Investigation of prognostic factors in patients operated due to synchronous primary endometrial and ovarian cancer.Material and Methods: Patients treated due to synchronous primary endometrial and ovarian cancer between June 1995 and November 2013 at the gynecological oncology clinic of İzmir Tepecik Training and Research Hospital were retrospectively analyzed. Clinical data of the patients were analyzed. Relationship between prognostic factors and patients' survival was evaluated. Survival analysis was performed using the Kaplan Meier method and cox regression analysis.Results: Fifty-two patients were examined in the study. The median age was 51 (28‒74). Pelvic and para-aortic lymphadenectomy was performed in 14 (26.9%) patients, pelvic lymphadenectomy was performed in 32 (61.5%) patients, and lymphadenectomy was not performed in 6 (11.5%) patients. Optimal surgery was detected in 53.8% of the patients. Both tumor histological type was endometrioid in 67.3% of the patients. Adjuvant radiotherapy was applied to 21 (40.4%) patients and adjuvant chemotherapy was administered to 44 (84.6%) patients. Recurrence was detected in 14 (26.9%) patients. The median disease-free survival was 61.5 months (3‒213) and the median overall survival was 75.5 months (6‒221). 5-year overall survival was calculated as 73.1%. In the patient group undergoing complete surgical staging, better overall survival was obtained compared to the group of patients who were partially or not (HR: 1.77; CI 95% 1.03‒3.02; p = 0.037). Optimal surgery improved disease-free and overall survival (HR: 0.15; CI 95 0.01-1.70; p <0.0001, HR: 3.73; CI 95% 1.60‒8.67; p = 0.039, respectively). The disease-free and overall survival of patients with early stages was better (HR: 0.27; CI 95 0.08-0.97%; p = 0.0003, HR: 5.65; CI 95% 2.21-14.43; p = 0.041). The 5-year overall survival was 82.9% for the patient group with both endometrioid tumor histology and 52.9% for the patient group with the non-endometrioid type (p = 0.023).Conclusion: In synchronous primary endometrial and ovarian cancers, prognosis is better in patients performed optimal surgery at an early stage. Complete surgical staging is an important prognostic factor. The 5-year survival rate is higher in patients with both endometrioid tumor histology.